Chronic ethanol consumption increases reactive oxygen species generation and the synthesis of pro-inflammatory proteins in the heart through TNFR1-dependent mechanisms.

We evaluated the role of tumor necrosis factor (TNF)-α receptor 1 (TNFR1) on ethanol-induced cardiac dysfunction. Male C57BL/6J wild-type (WT) or TNFR1-deficient mice (TNFR1-/-) were treated with ethanol (20% v/v) for 10 weeks. Increased protein expression of TNFR1 and NFκB p65 was detected in the left ventricle (LV) of WT mice chronically treated with ethanol. Echocardiographic analysis showed that ethanol consumption increased left ventricular posterior wall end-diastolic diameter and left ventricular posterior wall end-systolic diameter in WT, but not TNFR1-/- mice. Increased levels of TNF-α, interleukin (IL)-6, superoxide anion (O2-), thiobarbituric acid reactive substances (TBARS) as well as increased nitrotyrosine immunostaining were detected in the LV from WT, but not TNFR1-/- mice. Conversely, treatment with ethanol decreased nitrate/nitrite (NOx) concentration in the LV. Histopathological analysis showed that ethanol did not induce inflammatory infiltrates, necrosis or edema in the LV. No differences in the ventricular expression of iNOS, Nox2 or COX-2 as well as in the activity of superoxide dismutase (SOD), myeloperoxidase (MPO) and N-acetyl-beta-D-glucosaminidase (NAG) were found after treatment with ethanol. Our study provided novel evidence that ethanol consumption augmented the production of reactive oxygen species (ROS) and the synthesis of pro-inflammatory proteins in the LV through TNFR1-dependent mechanisms. These findings provided novel mechanistic insights about the contribution of TNFR1 in the initial steps of the cardiac damage induced by ethanol.

Tumor necrosis factor-α receptor 1 contributes to ethanol-induced vascular reactive oxygen species generation and hypertension.

We evaluated the contribution of tumor necrosis factor-α receptor 1 (TNFR1) to ethanol-induced hypertension and vascular oxidative stress and the possible role of perivascular adipose tissue (PVAT) in such responses. Male C57BL/6 wild-type (WT) or TNFR1-deficient mice (TNFR1-/-) were treated with ethanol (20% vol/vol) for 12 weeks. Ethanol induced an increase in blood pressure in WT mice and TNFR1-/- at 4 and 5 weeks of treatment, respectively. Treatment with ethanol increased tumor necrosis factor-α and interleukin-6 levels in aortas with or without PVAT (PVAT+ and PVAT-, respectively) from WT mice, but not TNFR1-/-. Ethanol increased superoxide anion (O2-) generation, thiobarbituric acid reactive substance concentration, and the activity of superoxide dismutase and catalase in aortas (PVAT- and PVAT+) from WT mice, but not TNFR1-/-. Conversely, ethanol consumption decreased the concentration of nitrate/nitrite in aortas (PVAT- and PVAT+) from WT mice, but not TNFR1-/-. Treatment with ethanol increased myeloperoxidase activity in aortas (PVAT- and PVAT+) from WT mice, but not TNFR1-/-. The major finding of our study is that TNFR1 contributes to ethanol-induced hypertension and oxidative stress in the vasculature. Additionally, TNFR1 plays a role in ethanol-induced increase in proinflammatory cytokines and neutrophils migration. However, PVAT does not counteract or aggravate the effects induced by ethanol.

Atresia congênita do tronco da coronária esquerda em adulto jovem: rasa e potencialmente fatal anomalia coronária / Congenital atresia of the left main coronary artery in a young adult: a rare and potentially fatal coronary anomaly

Relato do caso de paciente do sexo masculino, 35 anos de idade, com atresia congênita do tronco da artéria coronária esquerda, afecção extremamente rara e com poucos casos descritos na literatura. Nessa afecção, o óstio da coronária esquerda está ausente, o tronco da coronária esquerda termina em fundo cego e o fluxo sanguíneo se dá da coronária direita para a esquerda por pequenas artérias colaterais e retrogradamente. O diagnóstico diferencial envolve outras malformações congênitas (artéria coronária direita única e origem anômala da artéria coronária esquerda do tronco da artéria pulmonar) e doença aterosclerótica adquirida do tronco da coronária esquerda.

We report the case of a 35-year-old male patient with congenital atresia of the left main coronary artery, a raredisease with few cases reported in the literature. In this anomaly, the left coronary ostium is absent, the proximalleft main trunk ends blindly and blood flow is retrograde from the right to the left coronary artery by small collateralarteries. Differential diagnosis includes other congenital malformations (single right coronary artery and anomalousorigin of the left coronary artery from the pulmonary artery) and acquired atherosclerotic disease of the left main coronary artery.

Influência das dimensões finais do stent pós-procedimento nos resultados tardios do stent endeavor: análise preliminar com ultrassom intracoronário seriado / Influence of stent final dimensions in mid term outcomes of the EndeavorTM stent: a preliminary serial intra-vascular ultrasound analysis

INTRODUÇÃO: Vários fatores têm sido relacionados à necessidade de revascularização da lesão-alvo, sejam eles clínicos, angiográficos ou ultrassonográficos. Quanto aos últimos, a área mínima do stent pós-procedimento (AMS) tem sido correlacionada com áreas luminais mínimas intrastent tardias (ALM), em pacientes tratados com stents farmacológicos e não-farmacológicos. OBJETIVO: Avaliar a AMS de pacientes tratados com stents liberadores de zotarolimus EndeavorTM capazes de predizer ALM < 4 mm², aos seis meses de evolução. MÉTODO: Estudo retrospectivo com 47 pacientes e 50 lesões tratados com stents liberadores de zotarolimus, submetidos a ultrassonografia intravascular (USIC) no procedimento índex e no seguimento de seis meses. Correlacionou-se a AMS com a ALM. Por meio da análise de curva ROC, avaliou-se a AMS preditora de ALM < 4 mm² no seguimento de seis meses. RESULTADOS: Observou-se correlação significativa (r² = 0,64; P = 0,001) entre AMS (6 ± 2,1 mm²) e ALM (4,6 ± 2,4 mm²). Houve diferença significativa quanto à AMS dos grupos com ALM < 4 mm² vs. > 4 mm² (4,8 mm² vs. 6,8 mm², respectivamente; P = 0,001). Pela análise da curva ROC, encontrou-se AMS pós-implante > 5,7 mm² como preditora de ALM > 4 mm² aos seis meses [área sob a curva: 0,815; intervalo de confiança (IC) 95%: 0,68-0,95; P < 0,001], com sensibilidade e especificidade de 80%. CONCLUSÃO: Em pacientes tratados com stents EndeavorTM, a AMS > 5,7 mm² esteve associada a ALM > 4 mm² no médio prazo. Tais achados podem auxiliar o implante ótimo desses stents.

BACKGROUND: Several clinical, angiographic and ultrasonographic factors have been associated to stent restenosis and target lesion revascularization. As to intravascular ultrasound (IVUS) findings, the minimal stent area (MSA) has been correlated with minimal lumen areas (MLA) in patients treated with bare metal and drug eluting stents. OBJECTIVES: Evaluate MSA values of patients treated with EndeavorTM zotarolimus eluting stents capable of predicting MLA < 4 mm² after six months of follow-up. METHOD: Retrospective study with 47 patients and 50 lesions treated with zotarolimus eluting stents, submitted to IVUS at index and at the six-month follow-up. The MSA was then correlated to the MLA. ROC curve analysis was used to identify a MSA that could predict a MLA < 4 mm² at six months. RESULTS: There was a significant correlation (r² = 0.64; P = 0.001) between the MSA (6.0 ± 2.1 mm²) and MLA at six months (4.6 ± 2.4 mm²). There was a significant difference for MSA between the groups with MLA < 4 mm² vs. > 4 mm² (4.8 mm² vs. 6.8 mm², respectively; P = 0.001). ROC curve analysis identified a post-implant MSA of > 5.7 mm² as a predictor of MLA > 4 mm² at six months [area under curve: 0.815; 95% confidence interval (95% CI): 0.680.95; P < 0.001], with sensitivity and specificity of 80%. CONCLUSION: In this group of patients treated with EndeavorTM stents, MSA > 5.7 mm² was associated with MLA > 4 mm² at the mid-term follow-up. These findings may help achieve the optimal deployment of these stents.